| NPI | 1376145557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZELDRI VAN DER WATH Therapist 248-250-2530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2021-01-28 |